Being a parent or a caregiver is both rewarding and challenging. Caregiving can become even more challenging if your child has received a mood disorder diagnosis.

Children who live with a mood disorder can lead fulfilling, meaningful lives when they have effective treatment and support. For caregivers, being equipped with tools, information, and resources will assist you in finding the best way to help your young person and care for yourself throughout the process.

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Depression in Children

Depression is a serious but treatable medical condition that affects how a person feels, thinks, and acts. Though typically characterized by feelings of sadness, depression symptoms may appear as irritability or apathy.

Children and teens can be diagnosed with depression just like adults. However, depression manifests differently in young people than in adults. By knowing the signs and symptoms to watch for, you will know when it’s time to seek professional help.

Symptoms of Depression in Children

  • Frequent sadness, crying, or irritability
  • Loss of interest in activities that used to be enjoyable
  • Feelings of hopelessness, worthlessness, or guilt
  • Change in weight or eating (increased or decreased)
  • Fatigue or low energy
  • A decline in school performance
  • Sleep changes (more or less than usual)
  • Thoughts of suicide and/or self-destructive behavior

These symptoms are also prevalent in adults; however, some symptoms may appear different in children and teens. Younger children will have a harder time explaining their emotions because they don’t yet have the language for it. Children’s complaints may be about physical symptoms voiced as “my tummy hurts” or “my head hurts.”

It is important to remember: the younger the child, the less ability they will have to vocalize what they are feeling, which is why it’s important to consider their baseline and observe changes in behavior over time. Irritability is more common and possibly more severe for young people when they are depressed. Depression increases social withdrawal; however, teens may withdraw from their families more than their peers.

Depression Screening    Learn More about Depression

Bipolar Disorder in Children

Bipolar disorder is a serious but treatable mental health condition marked by intense mood, energy, thinking, and behavior changes. Symptoms for young people may emerge gradually or suddenly during childhood, adolescence, or adulthood. Bipolar disorder is most frequently diagnosed in the mid-20s. However, onset can occur earlier in childhood or during the teen years. Knowing the symptoms of bipolar disorder can be helpful to understanding if your child is experiencing a mental health concern.

Symptoms of Bipolar Disorder in Children

Bipolar disorder is defined by periods of mania or hypomania, which are times of abnormally elevated, expansive, or irritable mood accompanied by symptoms such as:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • Being more talkative than usual or feeling pressure to keep talking
  • Racing thoughts
  • Being easily distracted
  • Making risky or impulsive choices regardless of consequences

Individuals experiencing mania will have more than one of the above symptoms for at least seven straight days. Hypomania is defined as having more than one symptom for at least four straight days. One episode of mania can lead to a diagnosis of bipolar disorder, but most periods of mania are followed by a period of depression (note the symptoms above).

It is important to look for both signs of depression and mania or hypomania, as children may have depression symptoms before symptoms of mania. Adults are more likely to show symptoms of mania.

The most notable difference between bipolar in adults versus children is that children may experience the course of their condition more continuously than adults do. Adults tend to have more defined periods of depression and mania or hypomania, whereas children may have longer periods of rapid cycling. Rapid cycling occurs when someone moves quickly through both the depressed and manic states, sometimes even within the same day.

Both children and adults can experience rapid cycling moods, but current research finds rapid cycling more common in children living with bipolar disorder. Additional research around rapid cycling and children is needed to ensure this is not caused by a possible second diagnosis.

Bipolar Disorder Screening    Learn More about Bipolar Disorder

Finding a Clinician

Looking for a treatment team for your child is the first step in creating positive outcomes for your child’s wellness journey. The following list of questions is meant to assist parents to understand what questions can be helpful to ask when choosing and working with a mental health professional. Note that most pediatricians can be a great starting point in gaining referrals to mental health professionals.

Here are some questions you may want to consider as you begin to research different mental health workers:

  • Do they take my insurance or offer a sliding scale or affordable options?
  • What is their certification and licensing?
  • How much experience do they have with pediatric mood disorders?
  • Do they have references from other parents?
  • Do they have good communication skills with young people and families?
  • What type of therapy do they use, and what’s their approach to the process?
  • How do they define progress in treatment? Does it match up with what you define as progress?
  • What timeline of treatment should be expected?

Making the most of your first appointment

When you or your child begin to work with a mental health professional, there can be a lot of questions and information you want to explore during your first appointment. Here are some steps that will help you make the most of your appointment:

  • Bring relevant medical records for your child.
  • If your child is currently taking any medication, write down the name, dosage, and when you administer/or they take it.
  • Bring information on any allergies or any previous adverse reactions to medications.
  • If you have been tracking or taking notes about your child’s mood, have those notes handy.
  • Prepare a list of questions to bring with you. Having a written list of questions will help to ensure you do not forget to ask anything.
  • At the end of the session, ask if there is anything else you should know that has not been discussed.
  • Find out how you might follow up most effectively if you have additional questions.

Before your first appointment with either a pediatrician, mental health professional, and/or psychiatrist, consider the following questions to be prepared for discussing any changes you have observed with your child:

  • What are some behaviors you are noticing in your child that differ from their previous norm?
  • Has there been a stressful event recently—a big family move, divorce, conflict in the home, or death of a loved one—that may have your child feeling off-kilter?
  • What has your child been saying to you about their mood that would give you an indication something has changed?
  • Has your child expressed that they have been experiencing physical pain such as stomach aches or headaches that cannot be explained by a pediatrician?
  • What do the changes look like in your child? Irritable mood? Crying? Hyper behavior? Try to document the ranges of mood your child is expressing and if possible, at what time of day.

The process of determining your child’s diagnosis

Diagnosis can be a challenging process, especially when diagnosing children. The way children experience and explain symptoms is different from the way adults do. There are certain diagnoses that are more commonly diagnosed in children, such as Attention Deficit Hyperactivity Disorder (ADHD) or Oppositional Defiant Disorder (ODD). Sometimes the behavioral responses seen in children that live with a mood disorder, such as depression or bipolar disorder, can be misinterpreted as symptoms of other conditions such as ADHD or ODD. This is why you’ll need to engage in a discussion about the rationale for the diagnosis and see if there are any other conditions that also may have similar symptoms.

Here are some questions you can ask a clinician for more information about the diagnosis:

  • What is the diagnosis?
  • How is the diagnosis treated?
  • How is this diagnosis similar to or different from other diagnoses that may be relevant?
  • Is there any chance of comorbidity (meaning two or more conditions occurring at once)?
  • What steps are recommended for treatment for your child specifically?
  • How should follow-up occur?

Treatment Options

From the initial conversation and diagnosis, it is likely that several treatment options will be made available to you. The treatment options for children include individual therapy, family therapy, group therapy, seeing a psychiatrist, and taking medication. While these options are not all-encompassing, the ones listed are most commonplace in the treatment of mood disorders.

Individual Therapy

An individual therapist should be a licensed professional, preferably one who is experienced in working with children and families.

The questions listed below will help you as you identify and engage with a therapist:

  • Does the mental health professional take the insurance you have? If not, is there a sliding scale that can be offered to best accommodate your financial needs?
  • How often would your child have appointments? What does the therapist recommend as a schedule?
  • What methodology do they use in their practice? Ask them to explain that methodology, and their training.
  • Ask about the duration of the therapy they think will be recommended for your child.

If you have concerns about your child’s willingness to attend appointments, discuss those concerns.

Discuss with the therapist what indicators will be used to measure how well your child is responding to the therapeutic process.

Ask if the therapist can work collaboratively with other professionals in your child’s life, such as a school social worker, pediatrician, and/or psychiatrist. Asking a therapist to collaborate with other mental health professionals such as a school social worker, pediatrician, psychiatrist that is also working with your child will help the professionals understand the needs of the child more holistically. For example, the school social worker may observe something that a therapist working outside of that setting may not observe. When care teams can work together, better treatment outcomes are more likely.

Family Therapy

During family therapy, family members work with a therapist to solve issues related to the family unit. If a young person in your family is living with a mood disorder, it may put a strain on the family and change relationship dynamics. Engaging in family therapy can help to solve communication issues and address both the individual and collective needs of your family.

The questions listed below will help you as you identify and engage with a family therapist:

  • Does the mental health professional take the insurance you have? If not, is there a sliding scale that can be offered to best accommodate your financial needs?
  • How often would your family have appointments? What does the therapist recommend as a schedule?
  • What methodology do they use in their practice? Ask them to explain that methodology and their training.
  • Discuss with the therapist their approach to family therapy.
  • Will the family always be together for sessions?
  • Which family members should be involved?
  • How does the therapist plan to safeguard the individual feelings of each family member while working collaboratively?
  • Discuss the course of the family therapy process. How long will the sessions last? What indicators will be apparent if progress is being made?

Group Therapy

Different agencies and treatment centers offer group therapy as a way for similar individuals to meet with a mental health professional to work through stressors and symptoms.

If you are interested in group therapy for your loved one, here are some things you might consider:

  • Will your insurance be able to cover the group sessions? If not, is there a sliding scale that can be offered to best accommodate your financial needs?
  • How many members will be in the group, and what is the expectation for participation?
  • Will you or your child learn better in a group setting?
  • What approach is the clinician taking to facilitate the group? Is the group meant to be educational in nature or more about discussing individual feelings?
  • What are the outcomes someone might expect if they participate in the group?

Medication

Deciding whether your child should take medication can be a difficult decision. It is a decision to be made with careful consideration, as medication can affect a younger developing brain differently than it would an adult brain.
If the recommendation of the mental health professional is that trying medication might help, here are some questions you may want to consider:

  • What is the purpose of the medication? What does it treat?
  • How much should the dosage be?
  • When should the medication be given to my child?
  • What are the possible side effects?
  • Are there any interactions with this drug I should be aware of?
  • Typically, how long does it take for this medication to be effective?
  • How would we know if there was a need to try another medication or a different dosage if this medication does not work well?
  • What are any possible negative reactions when taking this drug?
  • Is the drug addictive? How would we phase off the drug if that becomes necessary?

How to Talk to Children About Mental Health

If you are the caregiver of a child living with depression or bipolar, you know how important it is to have thoughtful conversations with your loved ones about their diagnosis. These conversations will vary depending on your caregiving circumstance. The best way to discuss mental health with a younger person will be based on their age and developmental level.

Meeting children at their level of understanding

When talking to younger children about mental health, it may be easiest to compare a mental health condition to a physical health condition. For example, you can explain that when people live with diabetes, they must take insulin to keep them healthy and they probably go see doctors more than others. When you live with a mental health condition, you may also have to go see doctors more often and maybe take medicines.

When talking to younger children, caregivers can explain that it is normal to feel angry, sad, anxious, or irritable, and that everyone feels these things from time to time. It is when those feelings are intense, last for a long time, or interfere with school, friendships, or family relationships that we might want to talk to someone who can help.

When talking to older children about mental health conditions, it is important to validate what they are feeling. By the time children are approaching puberty, developmentally, they can think more abstractly and be more introspective about their own feelings. When caregivers begin to talk to teens about mental health conditions, they should come prepared to listen to the teen’s perspective.

Teen years can be a confusing time because of the hormonal changes associated with growing to adulthood. For teens, their bodies are changing, they are feeling new emotions, and they begin to navigate gaining independence from their family unit and forming more social bonds with peers. With all this change going on, it can be hard to discern what is a typical mood shift versus what could be a mental health condition that needs addressing.\

Understanding the child’s baseline can help clarify this. If you notice a teen moving away from their normal behaviors in a dramatic way, it may be a good time to check in. Starting those conversations from a place of love and care while listening closely to the teen can help you begin positively.

Tips for talking about mental health with teens and young people

Validate their feelings. After you have listened to your teen, let them know that you hear what they are saying. Tell them you empathize with what they are going through and that you will work to understand how you can support them. You can let them know that while it may not seem like it, many other people also struggle with mood-related concerns. Understanding that other people struggle may not make their feelings any easier to cope with, but it can be helpful to acknowledge that they are not alone in feeling this way.

Practice reflective listening. When you practice reflective listening, you listen closely to what the other person is saying, and then you repeat back to the speaker what you heard. In this way, you let the other person know they have been heard. Think of phrasing like “I am hearing you say…” or “…. am I getting that right?” Check in after you have reflected on what you heard to ensure you understood them correctly.

Ask direct questions. Having conversations about mental health can be difficult, so sometimes we may want to speak indirectly to figure out or determine how someone is feeling. We may think bringing up changes in mood will make the mood worse for the other person. This likely will not be the case, especially if you begin the conversation from a place of love and care. It is important to use direct language to avoid misinterpretations, which can further distance you from your teen.

Addressing suicide. Suicide can be very difficult and painful to talk about. This is an area where you may be tempted to use indirect language because you fear bringing up suicide will plant the idea in your loved one’s head.

Evidence shows that asking someone if they are thinking of or have thought about hurting themselves does not increase the likelihood that they will. Ask directly.

If you or someone you know is having thoughts of death or suicide, call 1-800-273-TALK or text DBSA to 741-741. If you need immediate assistance, call 911 or go to the nearest hospital emergency room.

Resources for Teens

Safety and Crisis Planning

In its most severe state, depression or bipolar disorders can cause a child to pose risks to themselves or others. Suicidal or homicidal thinking should be addressed immediately and may require hospitalization.

If a child shows signs of impaired judgment, self-control, or awareness, hospitalization may be recommended. If you or someone you know is having thoughts of death or suicide, call 1-800-273-TALK or text DBSA to 741-741. If you need immediate assistance, call 911 or go to the nearest hospital emergency room.

Having a plan for safety in advance of a crisis is important to consider for both the child and the other members of the household.

Things to consider for safety planning include:

  • Place items that could be used for self-harm out of reach of the child, including medications.
  • Know which hospital you will go to and who will take the child. If there are siblings that will need care, have a plan for them to be looked after.
  • If you cannot take the child to the hospital because of the severity of the circumstance, seek out crisis services. Identify a local mental health agency that offers these services and keep this information handy.

During a time of calm, remember to discuss safety plans with all family members so that there can be clearer communication during a crisis. It can be difficult, but during crisis situations, it is important to try and remain as calm as possible. If an adult is also demonstrating a strong stress response during a crisis, the child may become more upset. Children can feel very scared if they are in a crisis state. By staying calm and speaking softly, you can better help your child feel safe.

Learn More Create a Crisis Plan

Working with Educators

Schools can support the needs of children living with mood disorders in a variety of ways, including helping with social skill development, ensuring physical comfort in the classroom, modifying daily schedules as needed, making academic accommodations, and reinforcing positive behavior. It is not uncommon for children living with a mood disorder to feel overwhelmed by challenges at school. Identifying teachers and other school staff who can serve as a designated “safe” adult will assist the child in moments of hardship.

Parents can advocate for their child’s needs in the classroom by being transparent with the school about their child’s diagnosis. In certain cases, academic support can be provided to a student living with a mood disorder. 504 and IEP special education plans can provide a roadmap of custom accommodations to ensure the child has success in their learning environment.

Resources for Parents and Caregivers

Support for Parents

Support your family by caring for yourself. DBSA hosts an online community for parents and caregivers to share experiences and share tips.

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The Mood Crew

Early childhood is a time when young ones are learning about emotions and finding ways to express them. This fun and engaging educational program, designed for ages 4 to 10, helps adults start positive conversations about feelings with children.

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Outside Resources

Find more resources for parents and caregivers of a child or teen living with depression or bipolar disorder.

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